Efficacy, efficiency and effectiveness of gonadotropin therapy for infertility treatment

Abstract

Gonadotropin therapy is an essential element in infertility treatments involving assisted reproductive technology. In recent years there have been outstanding advances in the development of new gonadotropins, particularly with the production of gonadotropins using biotechnological resources. Recombinant gonadotropins have higher specific activity compared with urinary counterparts, thus allowing subcutaneous administration of minimal amounts of glycoprotein. As a result, recombinant formulations have a better safety profile despite an overall similarity in terms of efficacy for pregnancy, as reported in many randomized controlled trials and meta-analyses. Gonadotropins stimulate the ovaries to develop follicles and oocytes, which are the raw material for fertilization and embryo production. The resulting embryos are transferred (fresh or frozen-thawed) to achieve pregnancy. The efficiency of a gonadotropin should therefore measured by the amount of drug used, the number of oocytes/embryos produced, and the number of pregnancies achieved by transferring fresh and/or frozen-thawed embryos to the uterus (cumulative pregnancy). Comparisons between different gonadotropin preparations should also take into account other important quality indicators in reproductive medicine, such as safety and patient-centeredeness. Altogether, the aforementioned quality indicators favor biotech gonadotropins over biologic products in infertility therapy.

Understanding and managing the suppression of spermatogenesis caused by testosterone replacement therapy (TRT) and anabolic–androgenic steroids (AAS)

“… Source: Adapted from Esteves, 80 with permission granted via Creative Commons Attribution non-commercial 4.0 copyright public licence. …”

Actions and Roles of FSH in Germinative Cells

“…Furthermore, through these cells, this hormone indirectly Conversely, in women presenting ovulatory dysfunction, FSH treatment has been recommended for decades; for example, using human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) to stimulate the growth and ovulation of the dominant follicle in patients presenting anovulatory infertility. Novel therapies using biotechnology have been introduced; for example, recombinant gonadotrophin, which is purer than urinary-derived gonadotropins and shows better clinical efficiency [35,45,46]. Recombinant human FSH (rhFSH) has been shown to be efficient in patients with polycystic ovary syndrome (PCOS), which is anovulatory, in stimulating follicular growth [47][48][49].…”

Human Chorionic Gonadotropin and Related Peptides: Candidate Anti-Inflammatory Therapy in Early Stages of Sepsis

“…Later in 2000, recombinant hCG preparations became available ( 13 ). Currently, urinary and recombinant hCG preparations are widely available from several commercial sources ( 25 ), as they are commonly used in the management of infertility and prepubertal cryptorchidism, as well as for stimulating testosterone production in hypogonadal men.…”